Surgical rates in the era of biological therapy: up, down or unchanged?

被引:57
作者
Olivera, Pablo [1 ]
Spinelli, Antonino [2 ,3 ]
Gower-Rousseau, Corinne [4 ,5 ]
Danese, Silvio [3 ,6 ]
Peyrin-Biroulet, Laurent [7 ,8 ]
机构
[1] CEMIC, Gastroenterol Sect, Dept Internal Med, Buenos Aires, DF, Argentina
[2] Humanitas Clin & Res Ctr, Colon & Rectal Surg Unit, Rozzano Milan, Italy
[3] Humanitas Univ, Dept Biomed Sci, Rozzano Milan, Italy
[4] Univ Lille 2, Lille Univ Hosp, Publ Hlth Unit, Epimad Registry, Lille, France
[5] Univ Lille 2, Lille Univ Hosp, INSERM, LIRIC,UMR 995, Lille, France
[6] Humanitas Res Hosp, IBD Ctr, Dept Gastroenterol, Rozzano Milano, Italy
[7] Univ Lorraine, Nancy Univ Hosp, IN INSERM U954, Vandoeuvre Les Nancy, France
[8] Univ Lorraine, Nancy Univ Hosp, Dept Hepatogastroenterol, Allee Morvan, F-54511 Vandoeuvre Les Nancy, France
关键词
biologics; colectomy; inflammatory bowel disease; surgery; INFLAMMATORY-BOWEL-DISEASE; POPULATION-BASED COHORT; EARLY COMBINED IMMUNOSUPPRESSION; CROHNS-DISEASE; ULCERATIVE-COLITIS; CONVENTIONAL MANAGEMENT; TREATMENT STRATEGIES; ADALIMUMAB THERAPY; INCEPTION COHORT; NATURAL-HISTORY;
D O I
10.1097/MOG.0000000000000361
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Purpose of reviewThe aim of this review is to summarize data regarding surgical trends in inflammatory bowel disease in the prebiologic and biologic era, with a focus on population-based studies and randomized controlled trials (RCTs).Recent findingsThere is paucity of data in RCTs regarding surgical rates, with only a few clinical trials reporting them. From the available data, meta-analyses of RCTs have concluded that antitumor necrosis agents (anti-TNF) reduce surgical rates in ulcerative colitis and Crohn's disease. A large body of evidence from population-based studies from different regions of the world is available to evaluate surgical trends before and after the introduction of anti-TNF agents. The risk of surgery decreased significantly over the past six decades; these decreasing trends continued in the biologic era, which might indicate a potential beneficial disease-modifying effect of biologics. There is lack of data with nonanti-TNF biologics (i.e. anti-integrins and ustekinumab) regarding the risk of surgery.SummaryAlthough data from population-based studies and available RCTs suggest a protective effect from surgery of anti-TNF agents, definitive conclusions should be drawn only when more disease-modifying trials with different biologics and treatment strategies become available.
引用
收藏
页码:246 / 253
页数:8
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